Learn About the ICU

An Intensive Care Unit (ICU) is a department in the hospital that provides specialized care for patients. It is sometimes also called a critical care unit. The health care team in the ICU has experience treating patients with severe and life-threatening illnesses or injuries.

While your family member is in the ICU, they will be checked often by the health team, and may have many machines attached to them. Some of these machines are used to monitor the patient’s conditions – for example, to check heart rate. Other machines provide medications, or support failing organs, such as breathing machines that help the person breathe.

ICU Terms and Treatments

By learning more about medical terms and treatments, and legal requirements, you can make better support your family member in the ICU.

ICU Medical and Legal Terms

Here are some common medical and legal terms that are important to know

Advanced Care Planning (ACP)

ACP is a communication process wherein people plan for a time when they cannot make decisions for themselves. It includes reflection, deliberation, and determination of a person’s values and wishes or preferences for treatments at the end of life. It may involve nominating a substitute decision maker (see below). These expressions are generally made outside of the clinical context and are not a final medical decision; a medical decision requires a discussion with a doctor and consideration as to whether the wishes and preferences are clinically indicated.

Allow natural death

Allow natural death mean making the decision NOT to have any treatment or procedure that will delay the moment of death. It applies only when death is about to happen from natural causes, and you would still receive treatments to keep you comfortable (e.g. pain medication, oxygen, etc.)

Comfort Measures

Comfort measures are treatments that focus on keeping you comfortable (for example, pain relievers, psychological support, physical care, oxygen, etc.) but do not keep you alive artificially or cure any illness.

End-of-life care

End-of-life care is health care provided at the end of a person’s life. This type of care focuses on helping you live the way you choose and focus on what is most important to you during your last days or weeks of life.

Family Meeting

Family Meeting may occur in a clinical setting with the doctor, patient, other health care provider’s involved in the patient’s care, and the patient’s family and/or substitute decision maker. Topics may vary but may include updates on the patient’s health, prognosis, goals of care discussions, discharge options, etc. In the ICU, most often you can expect to have a family meeting within 72 hours of admission. You can always request such a meeting if you have things to communicate or discuss with the healthcare team. Speak to the bedside nurse or social worker if you would like to request a family meeting.

Frailty

Frailty is a patient health state associated with getting older, involving multiple serious health issues that increase an individual’s vulnerability. Frailty can occur as the result of a range of diseases and medical conditions – even fairly minor health events can trigger major changes in a person’s health status. We usually associate frailty with noticeable losses in a person’s physical, mental or social functioning.

Hospice Care

Hospice Care is care that aims to relieve suffering and improve the quality of life near the end of life. In some places, both hospice care and palliative care are used to refer to the same thing – this specific approach to care. However, some people use hospice care to describe end-of-life care that is offered in the community rather than in hospitals.

Hospice care strives to help patients and families by addressing physical, psychological, social, spiritual and practical issues along with their associated expectations, needs, hopes and fears. It can help prepare for and manage self-determined life closure and the dying process and help patients and families cope with loss and grief during the illness and bereavement.

Goals of Care

This is a communication process that differs from ACP as it usually occurs in a clinical setting, is focus on treating the clinical problems, and results in a medical decision (eg. Use or non-use of life sustaining treatments). It involves a competent patient or, if incapable, a substitute decision maker. When a substitute decision maker is involved, consideration of the patient’s prior wishes and advanced care plans are considered.

Organ Donation

Organ Donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient).

Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury. Make sure your family knows if you wish to be an organ and tissue donor. Even if you have registered as a donor, health professionals may still need to ask your family for consent before recovering organs or tissue. Donation can take place only if your family consents at the time of death.

Rounds

Health care providers round on patients in clinical settings regularly. In most places, iIt involves the team members coming by the bedside of the patient and discuss the patient’s condition, future plans and coordinating care. A doctor, resident, nurse and other members of the health care team may be involved. Some facilities may allow family members to attend rounds related to their loved one and will ask them to participate or ask questions.

Palliative Care

Palliative Care is holistic care that is focused on treating uncomfortable symptoms, helping you and those helping to care for you make decisions as your illness progresses, and providing psychological/social services and spiritual support during serious and life-threatening illness. It does not mean ‘giving up’ but rather a focus on supporting the patient and the family with this focus on symptom assessment and comfort measures.

Power of Attorney Property / Power of Attorney Personal Care

Power of Attorney for Property / Power of Attorney for Personal Care are terms that refer to people who are legally appointed to speak on your behalf. In different jurisdictions, they also may be known as “Healthcare Power of Attorney”, “Healthcare Agent”, “Durable Power of Attorney for Healthcare” or “Healthcare Proxy”. Usually, you will appoint and sign a legal document naming your Power of Attorney for Property / Power of Attorney for Personal Care and outlining their responsibilities.

Residential Hospice

Residential Hospice is a home-like environment where adults and children with life-threatening illnesses receive end-of-life care services.

Substitute Decision Maker

A Substitute Decision Maker is a person who makes medical decisions for someone else when they cannot make decisions for themselves. This person might also be known as a “surrogate decision maker”, “medical proxy”, “health representative” or “agent” or a “Power of Attorney for Personal Care”.

Symptoms

Symptoms are signs that you are unwell – for example, pain, vomiting, loss of appetite, or high fever.

Terminal Illness

A Terminal Illness means an incurable medical condition caused by injury or disease. These are conditions that, even with life support, would end in death within weeks or months. If life support is used, the dying process takes longer.

ICU Treatments

Arterial Line

An Arterial line (art line) is a thin plastic tube inserted into an artery to continuously measure the blood pressure. Regular blood tests are taken from it – most commonly to measure the levels of oxygen, carbon dioxide and acid within the blood.

Using local anaesthetic, the doctor inserts a needle and then the art line into the artery. The needle is removed. It is secured in place with a stitch. Although usually placed in the wrist, an art line may be positioned at the elbow, groin or foot. They commonly stay in place for several weeks. You may notice the fluid within the art line pulsating slightly. This is normal and is due to pulsations within the artery.

Balloon Pump

An Intra-Aortic Balloon Pump or IABP is a long inflatable tube positioned in the aorta, the main blood vessel which runs out from the heart. It beats in time with the heart and aids the pumping of blood to the rest of the body. It also helps supply additional blood and oxygen to the heart itself. A doctor inserts the balloon via a blood vessel in the groin. It is attached to a console which sits at the end of the bed. Helium gas is used to inflate the balloon in time with the heart.

Bilevel Positive Airways Pressure (BIPAP)

Also known as mask ventilation or non-invasive ventilation (NIV). Related & similar therapies are Continuous Positive Airways Pressure (CPAP).

When patients cannot breathe adequately, a BiPAP machine may provide additional oxygen and assistance with breathing. This may avoid the need to insert an ET tube (intubation). BiPAP is usually applied using a tight fitting mask to the face or nose. BiPAP is used in the ICU and sometimes in other hospital wards.

Bronchoscopy

A doctor performs a bronchoscopy by passing a flexible telescope into the patient’s windpipe (trachea). This may be needed when a patient has pneumonia, when there is a blockage in the airways or to aid the placement of other tubes (e.g. a tracheostomy) into the trachea. The doctor may take samples from the airways for analysis. Occasionally a small piece of lung tissue (biopsy) is taken. In ICU bronchoscopy is usually performed through a breathing tube (ET tube or tracheostomy). Sedation is given during the procedure.

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a medical procedure that attempts to restart your heart and breathing when the heart and/or lungs stop working unexpectedly. CPR can include assistance with breathing and pumping of the chest and electric shocks to try and restart the heart. If the patient survives, they will require a breathing machine and will be transferred to the ICU. CPR can be useful in some situations, but not in all situations. To learn more about CPR and whether it is right for you or your family member, see our CPR Video Decision Aid.

Central Venous Catheter (CVC), Central Line or CVP Line

A CVC is a thin plastic tube inserted into a large vein for the administration of intravenous medications and to monitor pressures within the body. Under sterile conditions a doctor inserts the CVC using a needle into either the neck, beneath the collar bone or in the groin. The needle is removed after the line has been placed. The CVC may stay in place for several weeks but will be removed as soon as it is no longer required.

Patients often require a dialysis machine when there is kidney failure or abnormal levels of acid and salts within the blood. It is also occasionally used to treat some drug overdoses. A doctor inserts a dialysis catheter (also known as a Vascath or Shiley) into a large vein in the neck or groin. Blood circulates through the dialysis machine, toxins are removed and the blood then returns to the body. As patients recover, the kidney function often improves and the dialysis machine can be stopped.

ECMO is only used in the sickest of intensive care patients when the heart and/or lungs are failing to respond to other treatments. Under sterile conditions a doctor inserts tubing into blood vessels in the neck, the groin or directly into the blood vessels near the heart (through the front of the chest in the operating theatre). Blood is drawn out of the body and into the ECMO machine where oxygen is added to it. The blood is then returned either into an artery or a vein. This keeps a patient alive while allowing time for the heart and/or lungs to recover.

Enteral Nutrition

Also known as: Nasogastric or NG Feeding Orogastric or OG Feeding Enteral feed. Enteral nutrition is a liquid form of nutrition which is passed into a patient’s stomach via a plastic tube inserted into the nose (NG tube) or mouth (OG tube). Patients who are attached to ventilators are not able to eat food the normal way. Most intensive care patients are fed in this way.

External Ventricular Drain (EVD)

An EVD is placed in a patient’s head to measure the pressure within the brain and to sample & drain spinal fluid (cerebro-spinal fluid or CSF). They are used in patients with severe head injury, brain haemorrhage or after neurosurgery. The EVD is inserted under strict sterile conditions by a neurosurgeon either in the ICU, emergency department or in the operating theatre.

Feeding tube

A feeding tube is a form of life support used to feed someone who can no longer swallow food. Nasogastric tubes and gastrostomy tubes are two common types of feeding tubes. Nasogastric tubes are inserted through the nose and pass down into the stomach or intestines. Orogastric tubes are inserted through the mouth and pass down into the stomach or intestines. Gastrostomy tubes are inserted through the abdomen into the stomach or intestine.

Chest Tube

Patients who have had chest or heart surgery, or trauma may need a Chest tube, a tube inserted through the chest wall to drain fluid or air from around the lung (or heart). A Chest tube may also be required to drain collections of fluid from the chest in other circumstances (such as pneumonia). Every Chest tube is inserted by a doctor under strict sterile conditions. It may be inserted while the patient is in the emergency department, operating theatre or intensive care unit. It is stitched in place underneath the armpit or at the base of the breastbone. The Chest tube is connected to a drainage bottle or collection system positioned at the side of the bed. You may see fluid in the tubing going up or down or bubbling.

Inotropes

Also known as: Vasopressors, vasoconstrictors, Vaso-active drugs, inoconstrictors, and inodilators.

Inotropes are drugs given to increase the blood pressure and support the function of the heart. They are given via a CVC (see CVC) into a large vein. Different types of inotrope (e.g. adrenaline, noradrenaline, milrinone) are used in various situations. Inotropes are commonly used in the ICU.

Intravenous (IV)

An intravenous (IV) is a way to give you ﬂuids or medicine through a vein in your hand or another part of your body.

Intravenous Cannula (IVC)

Also known as IVC, or IV cannula Drip.

An intravenous cannula is a small, soft piece of hollow tubing inserted into a vein, usually in the back of the hands or the arms, which is then used to administer intravenous medications and fluids. They are used as an alternative to CVC (see CVC) when the latter is not required.

Intubation

Also known as insertion of a breathing tube (an endo-tracheal tube, ET-tube or ETT).

If a patient is unconscious or has severe breathing difficulty, then an ETT is placed into the windpipe (trachea). This is then connected to a breathing machine known as a ventilator. The ventilator provides assistance with breathing and additional oxygen. A general anaesthetic is given and a doctor inserts an ETT into the trachea via the mouth (or occasionally via the nose). Sometimes the procedure is done under local anaesthetic using a flexible telescope (see Bronchoscopy). Once the ETT is confirmed to be in the right place it is secured with a special holding device. The ETT can be uncomfortable for some people; sedation may be given for comfort while the ETT is in place.

Life Support

Life support is any treatment that replaces or supports a failing bodily function without fixing the underlying problem. Life support can mean medical or surgical procedures such as a feeding tube, breathing machines, kidney dialysis or CPR. All of these use artiﬁcial means to restore and/or continue life. Without them, the patient would die. Once the ETT is confirmed to be in the right place it is secured with a special holding device. The ETT can be uncomfortable for some people; sedation may be given for comfort while the ETT is in place.

You may have several different discussions with the health care team about life support, including whether to start life support or not, whether to continue life supports once they have been started or if there should be more or fewer life support treatments.

Lumber Puncture (LP)

Also known as a Spinal tap.

An LP is performed to sample the fluid from around the spinal cord and brain. Under sterile conditions a doctor inserts a small needle through the lower part of the back and draws off a small amount of fluid. An LP may be done to measure the pressure inside the spine and brain or to check for conditions such as meningitis.

SWAN GANZ CATHETER PULMONARY ARTERY CATHETER (SWAN)

A Swan is a thin piece of tubing inserted via a vein in the neck or just beneath the collar bone. Under sterile conditions a doctor inserts the Swan using a needle. The needle is removed when the Swan is in place. The tubing then passes through the heart chambers and into the main blood vessel in the lungs (the pulmonary artery). It is used routinely during heart surgery and also when patients need large doses of medications (inotropes) to support the blood pressure and heart function. A Swan measures how well the heart is functioning and monitors pressures within the heart and lungs.

TRANS-ESOPHAGEAL ECHO (TEE)

A TEE is a specialised ultrasound examination of the heart. A doctor passes an echo probe through the mouth of a patient and into the gullet (oesophagus) and then the stomach. This allows inspection of the heart and major blood vessels from inside the chest to see if there are any abnormalities. It also provides information on how well the heart is working. Sedation is given to the patient during the procedure.

Total PARENTERAL NUTRITION INTRAVENOUS FEEDING (TPN)

TPN involves introducing nutrition directly into a patient’s vein. It is usually given via a CVC (see CVC). It is used when it is not possible to feed a patient via the stomach and gut. It is often possible to switch back to normal feeding via the gut as the patient’s condition improves.

Tracheostomy

When a patient is attached to a ventilator for a prolonged period, a tracheostomy is usually performed. This is a plastic tube placed directly into the windpipe (trachea) through the front of the neck. It is more comfortable than a breathing tube through the mouth and often improves liberation from the ventilator. Under a general anaesthetic and with local anaesthetic and strict sterile precautions, a doctor performs a small operation to insert the tracheostomy. This is usually performed in the intensive care unit, although sometimes in the operating room. Speech and swallowing are sometimes possible when a patient has had a tracheostomy in for some time. The tracheostomy may ultimately be removed when the patient has recovered, leaving a small scar.

Transfusion

Blood transfusions are required to correct low blood counts (low haemoglobin, anaemia) or replace blood loss due to bleeding. Other blood products listed above are used to correct abnormal or low levels of clotting factors (if a patient is bleeding or is at risk of bleeding during a procedure) and antibodies.

Urinary Catheter

Also known as an In-Dwelling Catheter (IDC).

A Urinary Catheter (IDC) is a soft tube inserted into the bladder through the urethra. It drains urine from the bladder continuously, removing the need for a patient to empty the bladder on their own. A small balloon at the tip of the catheter holds it in place within the bladder. It is essential for patients who are heavily sedated, have an epidural catheter in place, or who have limited mobility and are therefore unable to walk to the toilet. It is also used to closely record urine output. The catheter is connected to a drainage bag which holds and records the amount of urine passed.

Vascath

Also known as a Dialysis line or Vascular Catheter.

A Vascath is a tube inserted into a large vein for dialysis (when there is kidney failure – see Dialysis) or for plasmapheresis (the removal of certain proteins from the blood). It is similar to a CVC. Under sterile conditions a doctor inserts a needle and then the vascath into either the neck, beneath the collar bone or in the groin. The needle is removed and the vascath is left in place for up to several weeks. The vascath is removed when it is no longer needed.

Ventilator

When patients cannot breathe adequately or have decreased level of consciousness, they may need to be attached to a ventilator (via an ET tube or tracheostomy – see Intubation and Tracheostomy). This is a common reason for admission to an intensive care unit. The ventilator provides additional oxygen and assistance with breathing. Patients on ventilators via an ETT often require sedation. When a patient no longer needs ventilator support it is weaned and the ETT removed. If a patient requires ventilator support for a long period of time (usually more than 10 days) a tracheostomy is commonly required.

Who’s Who in the ICU?

There are many health professionals working in the ICU, including:

Doctors

Specialized ICU doctors are available 24 hours a day to answer questions and provide care. Along with an ‘attending’ physician (the main doctor looking after your family member), you may see specialists, doctors who specialize in a specific disease or injury. You may also see ICU Fellows or Residents – these are physicians that are in training and will be supervised by a more experienced doctor.

Nurses

Critical care nurses are highly skilled and provide all physical and emotional aspects of care for very ill patients. The critical care nurse provides education and supports patients and substitute decision makers as
they make decisions. Families can turn to the critical care nurse with questions, for information, or to share their concerns and fears.

Respiratory Therapists (RT)

RTs help to manage breathing or respiratory problems in the ICU by administering breathing treatments that are prescribed by the healthcare providers. They also monitor and adjust breathing machines.

Social workers

Social workers can provide family members with guidance and counseling and can also help you organize family meetings. They are very knowledgeable about support available in the community and can help you access these resources if needed.

Physiotherapists (Also Known As Physical Therapist)

If required, physiotherapists can help your family member by helping them sit up and get out of bed as early as possible and in developing a plan to get and keep them moving when they are ready.

Pharmacists

Pharmacists review all of the medication orders in the ICU to ensure that drugs are being used appropriately and to alert the team of any possible side effects or problems if more than one drug is being used at the same time.

Nutritionists and Dieticians

Registered Dieticians work carefully with the health team to develop specific nutritional plans for each patient and recommend the best way to feed patients based on their condition.

Spiritual Support

Most hospitals have a multi-faith spiritual care professional, such as a Chaplain, or other individual who can provide spiritual guidance or support for patients and their family members. Some hospitals also have priests, rabbis, and other religious leaders available to visit with you and your loved one upon request.

Unit Clerks

Unit Clerks
Usually located at the nursing station/desk, unit clerks perform clerical duties in the ICU. They are a good resource for locating your loved one, getting in contact with a member of the health care team, or finding resources on the unit to address your concerns.

Volunteers

You may see a number of volunteers in the hospital and in the ICU, including ‘patient advisors’, volunteers who can provide guidance, information about hospital resources, or just a friendly ear. Hospital volunteers usually receive training from the hospital and many of them have experience being with family members in the ICU.

Clinical Ethicist

Many hospitals have ethicists who can assist patients and families in making decisions at the end of life.